Is 5 Years Old Too Young to Medicate? Long Story...

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Since my son first started exhibiting the signs of autism when he was about two years old, I have insisted that I would not medicate him, that I would find other ways to deal if he was autistic. Nathan is now five and a half years old and diagnosed with PDD-NOS. He is intelligent and funny, and he is getting a fair amount of help. His psychologist retired a few months back, but Nathan is in Kindergarten and has a lot of assistance through the school. He has an IEP and an aide with him all day, everyday. The kids in his class seem to love him - there are always kids running up to us at the store or park, and they are always excited to tell their parents, "That's Nathan from my class".He is also reading incredibly well and doing good in school. Over the last six months or so, he seemed to be making great strides on his speech and behavior. I couldn't be happier. But...

For the last several weeks, Nathan's behavior has been changing. He is reverting back to using a lot of echolalic speech. He is staring off into space a lot and up until this point he has only had a very minor issue with making eye contact. Now, when we are trying to talk to him, he can only focus for a few seconds at a time. When we are talking with Nathan, he will start talking over us while we are mid-sentence. He will just start saying something random that has nothing to do with anything. This past week, Nathan has been going into screaming, crying, full-blown tantrums when we try to get him to eat dinner. We give him the foods we know he likes (cheeseburgers, tacos, grilled cheese sandwiches) and he will just go into a fit, refusing to eat. As much as a hate to admit that I lose my cool from time to time, when he went into a terrible fit last night when I gave him dinner, I kept asking him what was wrong, but all he would do was scream and cry. So, I got down to his level and told him he was going to sit down and eat, and he screamed "No" right in my face as loud as he could. I then yelled right back at him and told him he was going to eat. But it didn't faze Nathan. He got right back in my face and screamed "No" several times. He isn't sick and there have been no major or minor changes that have occurred recently that I could think of that would cause such a dramatic change in my boy.

In addition to the problems at home, Nathan has been having behavioral problems at school the last month or so. We had reports that Nathan has went on cussing-sprees, has hit his afterschool care teacher, kicked a little girl who was sitting next to him in the face and he has been seen urinating on the playground. I don't know what is going on, but he seems to to reverting back to bad behaviors and defiance. And now that he is using a lot more echolalic speech and having the eating issues, I can tell there is something that is not right with him.

I'm wondering if there is something else, some sort of problem that is affecting his behavior so tremendously. I am not a doctor and I may sound foolish, but i'm actually worried that he might have something in addition to the autism, like bi-polar disorder or schizophrenia. Ironically enough, I have an aunt who is both bi-polar and schizophrenic, but she is nearly 50 and not autistic, so it would be hard to compare my son with her. But it just has me thinking "What if"...

Whether or not it is just the autism or an underlying condition, I was wondering if any of you parents have a young autistic child who is currently or was previously on medication. Does it help? What symptoms does it help with? What type of medication are they/were they on (antidepressants, antipsychotics, amphetamies,etc)? Does the medication change your child's personality (I hope not) or just treat the symptoms?

I am going to get Nathan to a specialist as soon as I can, but I wanted to talk to other parents before I consider the idea of medication. But, as anti-medicating as I have been, I have a feeling we have reached that point...

Last edited by NathansMommy on 23 Nov 2011, 11:59 pm, edited 1 time in total.

I would try everything else first, mainly because you don't know what is causing it. I would exhaust behavioral avenues first. There are many ups and downs and you never know what he is going through, so it makes it hard. I can say there are times when you feel they are reverting back, but it usually cycles and you get through it. Perhaps school is stressful, or he is not getting what he needs. Sometimes growing, getting loose teeth, change in weather, or holiday seasons are enough to throw kids off. I'd wait and see how else you can support him before trying medication. It would be a shame to miss the opportunity for him to learn new skills and for you to learn more about how your son experiences the world. I know it seems scary, but both of you will get through it!

I have found with my own daughter that there are occasional periods of extreme regression like you describe. In the earlier years we did resort to trying medications but always with poor or short lived effectiveness and horrible side effects. I believe that some children do need medication to help them and they respond well to them. However, I have found a lot of instances like ours where they cause more harm than good. Making that decision is a hard one and only you can decide whether a trial of a med is warranted. I would be willing to bet that this is a regression and he will come out of it in time.

This sounds like regression to me and not an emotional or focus issue. If this had been going on for years and nothing ever worked, I would say its fits the pattern where medication seems to help, but that is not what I'm reading. I know triggers are near impossible to find, but this sounds responsive. You want the trigger.

I am so sorry to hear about the regression. We all know it happens, but I don't think that makes it any easier to deal with.

What happens if you take him out of school for a week? I think I would start with experiments like that. And lots of detailed interviews.

Do remember that sensory issues change and new ones can kick in at this age. I think that was when my son developed issues with noise and crowds.

My son had softer regressions, and they tended to revert almost as fast as they seemed to start. Who knows for sure why. We would focus hard on him for a while, learn new things about him, and then it seemed to smooth out. There is no straight course with AS kids.

I think talking to a BCBA about more effective ways to parent a child with autism is more in order than medication.

I don't know, they were on track, so the parenting was working. Something changed. I'm not sure how anyone outside the home can really figure that out.

I think behaviorist can offer some insight if they are experienced. They have seen regressions and may be able to pinpoint triggers that others miss. I'm not saying that it is the cure-all, but many are able to give some insight into behavior changes and how to support them.

what medication would he be given? i would say almost universally that whatever his issues are, medicating a child this young could only lead to further developmental issues for his growing brain. of coarse i am not any kind of medical expert, so you need to seek the advice of a medical expert. Perhaps a few different ones if possible.

I know you said he isn't sick, but, well, are you absolutely, positively sure? No ear infections, no possible tooth pain, no digestive issues, no nothing? If you have already thoroughly explored possible physical causes then yes, it's definitely time to pursue other ways of trying to deal with things. However, I would recommend that you first be very, VERY sure that there is nothing physical going on. Sometimes behavior problems are the only symptoms that are particularly visible.

I also had extreme regression with my daughter and strangely enough around the same age. She became nearly non verbal only echoing what we would say at times. She started being very obsessive again about her rituals, like if we missed a rock that she typically stepped on on the way to school she would realize it half way there and fly into a meltdown and I would sit with her until she would say something like rock or start running back toward home. After she stepped on the rock she was fine. We asked if there were any changes at school, they said she was more quiet and cried more but nothing had changed at school. After months of being worried and posting here and watching her slip away further into herself I found out that the therapy center had supposedly told her aide that she was no longer allowed to speak English to her (we moved to France last year and Maddy only learned to speak English between 3 and 4 years). We did find that it was actually the aides fault as she did not listen to the therapist, what she actually told her was to try to use more French not to cut off the English all together. The reason we got this aide was that she said she could speak English (shes actually not so good at it). Anyway, this may not be your sons issue but sometimes one seemingly small stress (which is actually huge in my opinion but the teacher and aide didnt realize it) was causing severe stress to my daughter and she still has not fully recovered from it.
She is using some French words but is having issues now that she is in 1st grade and in the "big" school. The therapy center keeps trying to get her aide to come to the center to get help and she keeps refusing. My husband had a meeting today and we are more irritated with my daughters aide now. The other day she told me that Maddy has been having a lot of meltdowns at school (I should have been informed of this way before) and she does not know what to do. Well.....maybe if you would LEARN and go to the center you would know. Anyway, enough of my problems. I hope you find out what is going on with your little guy, be a detective and make sure nothing is going on at school because what may seem like nothing to them could be huge to him.

I agree with the suggestion of regression -- but on top of the regression I wonder if something new is a factor, something that has not been found or uncovered.

Did anything new change recently? I'm talking about combing through every detail of home/school including any dietary changes, even changes in type of clothing (fabrics), change in household items used (detergents, cleaners).

This may be totally off the mark but I'd want to rule out any factors that may be causing what appears to be a sudden switch -- and once all these are ruled out then I'd say it is regression.

If this is the case, or if you think an additional mental health issue has come into play, then he needs an evaluation.

What kind of medication are you considering? From your post it sounds like you are getting very frustrated/burnt out by your son's behaviors. The behaviors you describe don't sound to me like the type of thing that typically requires medication.

Everybody has bad days, or even a bad week. But if the changes in behavior are lasting a month or even two, it might be worth looking into medication. Usually for things like tantrums and aggression, very small doses of antipsychotics are used and are pretty safe. A few years ago I was on .25 mg of Risperidone (a VERY small dose!) which help tremendously with meltdowns and tantrums. Of course, you should always discuss medications with a doctor. You should find a child psychiatrist that specializes in autism spectrum disorders, if you don't have one already.

Since he started kindergarten this year, he's probably been in school for about 2-3 months. K is a big change from preschool -- new teacher, new classroom, more kids, more expectations -- and there's a good chance he's stressed out by all that. You could request that the school do a Functional Behavioral Analysis to figure out what is going on with him.

The behaviors you are describing don't sound like ADHD, focusing-type issues. There may be a lot of anxiety going on, but since he wasn't exhibiting a generalized anxiety before K started, I would lean toward trying to find the causes and some solutions first.

Just FYI -- I'm not anti-medication. My own 6 year old son is in kindergarten, and we have decided to do a trial of ADHD medication for him. However, his focusing problems have been apparent for 1.5 years, and even a private OT with sensory integration training working one on one had a lot of difficulty keeping him on-task. When I asked, she said she thought medication might be helpful for him.

Last edited by zette on 25 Nov 2011, 9:00 pm, edited 1 time in total.

Sorry if I wasn't clear (I don't think I was). I don't mean to say that the OP's parenting caused any problems whatsoever... but that, in light of a regression, different parenting skills might be needed to help the child. A really good BCBA can do a LOT, when they take the time to get to know the family and the child. It takes time and patience, which many don't have, but when they do, it can be awesome.

That makes sense. Thank you for taking the time to clarify.